Synchronous Versus Sequential Liver, Colorectal Resections

Improvements can be made to provide procedure-specific national benchmarks for postsurgical outcomes.

The debate about whether surgical resection of primary tumors and metastatic tumors should be performed at the same time or in separate operations continues as researchers at the Mayo Clinic delve into the issue.

Investigators provided a detailed comparison of patient outcomes associated with synchronous and sequential colorectal and liver resections in patients with stage IV colorectal cancer, identifying some benchmarks for surgical practice.

According to the data, improvements can be made to provide procedure-specific national benchmarks for postsurgical outcomes. Findings from the study were vast and provided much information about the practice of resection.

According to the data, major complications after synchronous liver and colorectal resections vary and are related to the extent of liver resection performed and the type of colorectal surgery performed. Additionally, the researchers observed that patients with higher risk surgeries experienced poorer outcomes, regardless of surgery timing.

Finally, synchronous resection of primary colorectal tumors and metastatic liver tumors is safe and effective in patients who require only minor liver resections.

“Our findings also show that performing pre-operative risk assessments on patients who require both liver and colorectal resections could allow surgeons to more accurately predict patient outcomes and assist in preoperative planning and counseling these patients,” said study lead author David Nagorney, MD, a general surgeon at the Mayo Clinic.

The study evaluated a large, multi-institutional database to identify a pool of 43,408 patients who underwent colorectal and liver resections for stage IV colorectal cancer.

“Our primary aim was to establish the magnitude of risk that each component operation, both liver and colon, contributed to synchronous resections in order to determine which combination of colon and liver operations were most safe to be performed at the same time,” Dr. Nagorney said.

Past studies only considered the extent of liver resection performed and not the type or location of colorectal resection as was done in this study.

“We wanted to test the hypothesis that both the extent of the liver resection and the location or type of colorectal resection influence the overall risk and patient outcomes associated with these operations,” said first author, Christopher Shubert, MD, a surgeon and Kern Scholar at the Mayo Clinic.

The researchers assigned risk levels to different surgeries and then evaluated patients 30 days post-operation to determine outcomes among patients within similar risk groups. They also compared outcome data between two groups of patients within each risk category — those who had synchronous colorectal and liver resections and those who had these operations sequentially.

“Stratifying patients using risk categories allowed us to make more accurate comparisons between patient outcomes associated with synchronous versus sequential resections,” Dr. Schubert said.

Medical professionals will need more research to put the debate about synchronous versus sequential operations to rest. For now, the results of this study lead scientists to believe that location and type of surgery performed matter in measuring risk factors for synchronous operations and synchronous operation is safe in patients who require only minor liver resections.